Naval Health Care New England COMMAND ORIENTATION TRICARE BRIEF HEALTH CARE OPERATIONS NOV 2005

Do you need this brief?  If you/family plan on needing any type of healthcare during your tour… you need this brief.  If you work in any capacity at an MTF… you need this brief.

Agenda  What is TRICARE?  How do you access primary care and specialty care in this area?  How do you access your PCM/PCM Team 24/7?  How do you obtain prior authorization for urgent care?  How do you notify your PCM of an emergency visit?  TRICARE Region North/The Business of Healthcare

What is TRICARE?  Military’s Healthcare System (Direct Care/Network).  Consists of three regions-TRICARE North, South and West.  Health care is delivered in partnership with a Managed Care Support Contractor; Health Net Federal Services providing a “network” of civilian facilities and individual providers to augment the direct care system.

Managed Care Support Program

Health Net Federal Services Enrollment (TRICARE Service Center) Process Claims Provider Network Medical Library (online) Call Tricare or via

Enrollment  Enrollment is the responsibility of the MCSC; HNFS. Enrollment forms are processed at their TRICARE Service Center. Selection of a PCM.  Active Duty must complete a TRICARE enrollment form.  Family members may enroll to Prime or remain in Standard, or Extra. Prime will enroll to the MTF.  Update DEERS at PSD.

NHCNE Managed Care Program NHCNE Call Center  Primary Care Appointing  Facilitates 24/7 access to PCM (Urgent Care Authorization) Referral Management Office  In house Specialty Care Appointing  Processes referrals to the network Enrollment Management  Facilitates PCM assignments and capacities Health Benefits Advisors Case Management Marketing

NHCNE CALL CENTER NAVY MED Naval Health Care New England NBHC PortsmouthNBHC Saratoga Springs NBHC Brunswick NACC Newport NACC Groton

Hours of Operation NACC Groton M-F; Sat-Sun; NACC Newport M-F; AD Early access; Sat-Sun; NBHC Brunswick M-F; , Wed; NBHC Portsmouth M-F; NBHC Saratoga Springs (Active Duty Only Clinic) M-F;

Services Available at the MTF  Primary Care  Specialty (Consultative) Care  General and GYN Surgery (Newport/Groton)  Orthopedics (Newport/Groton)  Dermatology (Newport/Groton)  General Dentistry/Oral Surgery (Newport/Groton)  Optometry (Newport, Groton, Ports, Bruns)  Physical Therapy (Newport, Groton, Ports, Bruns)  Laboratory  Basic Radiology (Groton CTs )  Pharmacy  Mental Health (Newport/Groton)

Urgent Care  Call the NHCNE Appointment Call Center at NAVY MED ( ) 24/7 to contact your PCM.  During normal business hours the PCM team will handle the call (Quick Response Nurse) and may provide you a same day appointment, advice on how to handle the immediate situation or authorize care.  Urgent Care requires an authorization from your Primary Care Manager (PCM) prior to you seeking care or the MCSC will charge POS.

Urgent Care  Call the NHCNE Appointment Call Center at NAVY MED ( ) 24/7 to contact your PCM.  After business hours the After Hours Call Center staff will facilitate an acute appointment or contact the PCM On Call who will contact you directly.  The PCM On Call may provide you advice on how to handle the immediate situation; suggest an acute appointment the next business day, or authorize urgent care.

Emergency Care All TRICARE beneficiaries, in the event of a life-, limb-, or eyesight-threatening emergency, should call 911 or go to the nearest emergency department for care. Emergency Care does not require an authorization. If enrolled to prime within the MTF call the NHCNE Call Center (1-888 NAVY MED) within 24 hours to notify your PCM of a visit to a local ER. If you are out of area contact Health Net Federal Services within 24 hours at TRICARE to notify of an emergency admission or ER visit to coordinate continued care and ensure proper claims processing.

TRICARE Region North

TRICARE North Region Stats Region consists of 23 states from Maine to North Carolina and from Wisconsin to Kentucky Range of DOD healthcare facilities all Services represented: 4 medical centers, 12 bedded facilities and 70 clinics 3 Multi-Service Markets (Tidewater, National Capital Area (NCA) and Ft Bragg/Pope 82 Prime Service Areas (PSA) majority located around Medical Treatment Facilities (MTFs) Health Net Federal Services network has over 83K providers, most residing in PSAs

Population Demographics Northeast Sub-Region Comprised of 1 bedded facility and 14 clinics 31% of the Northeast eligible population is enrolled in TRICARE Prime at MTFs

NHCNE Enrollment NHCNE MTF Enrolled NACC GROTON13,370 OPS FORCES GROTON2,699 NACC NEWPORT10,848 NBHC SARATOGA SPRINGS2,686 NBHC PORTSMOUTH3,286 NBHC BRUNSWICK4,606 OPS FORCES BRUNSWICK1,921 As of: October ,416 Note: Students onboard less than 179 days are not enrolled

Business of Health Care It’s about continually finding ways at every level to provide accessible, efficient, economical, high quality care as a member of the health care team, by: Keeping the patient and staff safe, Maximizing the provider’s time, Negotiating the best price for supplies and services, Identifying better products or processes, Maintaining the facility, Helping patients access the appropriate level of care, Having the right amount and mix of labor available.

Business of Health Care How do we mitigate healthcare costs? Answer: Set Workload Standards 1. Monitor Productivity 2. Improve Data Accuracy 3. Recapture Network Care 4. Improve the Value of Care

Wrap Up  Utilize NAVY MED to access a PCM 24/7, to make primary care appointments, notify PCM of ER visit.  Utilize for current services and command information.  Go to the Referral Management Office to book in-house specialty care or process a network referral.

Wrap Up Health Net Federal Services is our health care partner. Ensure that DEERS is current and accurate. “The business of Healthcare is our responsibility we must mitigate healthcare costs in order to maintain the TRICARE benefit now and into the future”.